Immediate IUD placement within 48 hours of second-trimester medical abortion resulted in lower IUD use at 12 months compared to delayed placement at 2-4 weeks (51.6% vs 69.2%, p=0.04).
RCT (n=179)
Yes
Does immediate IUD placement within 48 hours after second-trimester medical abortion improve long-term IUD use at 12 months compared to delayed placement?
Immediate IUD placement after second-trimester medical abortion results in lower long-term IUD use and higher expulsion rates at 12 months compared to delayed placement.
Absolute Event Rate: 51.6% vs 69.2%
p-value: p=0.04
INTRODUCTION: Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after second-trimester medical abortion. MATERIAL AND METHODS: We performed a 12-month follow-up of a multicenter randomized controlled trial comparing IUD placement within 48 h (intervention) with placement at 2-4 weeks (control) after medical abortion with 85 to 153 days' gestation. Secondary outcomes such as proportions of long-term IUD use, subsequent pregnancies and abortions, and participant satisfaction are presented (ClinicalTrials.gov NCT03603145). RESULTS: A total of 179 women were included. The 12-month follow-up rate was 71.1% (64/90) in the intervention group and 73.0% (65/89) in the control group. Fewer women in the intervention group were using an IUD after 12 months: 51.6% (33/64) vs. 69.2% (45/65, p = 0.04). The total expulsion rate over 12 months was 36.4% (24/66) in the intervention group compared to 3.1% (2/65) in the control group (p < 0.001), with only two IUDs being expelled between 6 and 12 months, both in the intervention group. The most common contraceptive method at 12 months was any hormonal IUD at 54.3% (70/129). Among IUD users at 12 months, the overall satisfaction with their contraceptive method was high, at 88.3% (68/77). In the intervention group, 26.2% (16/61) had at least one subsequent pregnancy within 12 months compared to 13.6% (9/66, p = 0.08) in the control group. We found no significant difference in the number of subsequent abortions; 13.1% (8/61) in the intervention group and 6.1% (4/66) in the control group reported at least one subsequent abortion (p = 0.23). CONCLUSIONS: Immediate IUD placement after second-trimester medical abortion did not lead to a higher proportion of IUD use at 12 months compared to delayed placement. Rather, immediate IUD placement was associated with a higher incidence of expulsion and lower use; however, no significant increase in subsequent pregnancies or abortions was observed. High satisfaction levels with IUD use were reported in both groups, but women with immediate placement were less likely to recommend a friend to use an IUD post abortion.
Hogmark et al. (Wed,) conducted a rct in Second-trimester medical abortion (n=179). Immediate IUD placement (within 48 h) vs. Delayed IUD placement (at 2-4 weeks) was evaluated on IUD use after 12 months (p=0.04). Immediate IUD placement within 48 hours of second-trimester medical abortion resulted in lower IUD use at 12 months compared to delayed placement at 2-4 weeks (51.6% vs 69.2%, p=0.04).